choosing wisely -- tests to avoid in kids

choosing wisely came out with 10 tests/treatments that pediatricians/fam practice/ER providers should question (see http://www.choosingwisely.org/wp-content/uploads/2014/03/AAP10things-march2014.pdf ). nothing very surprising.

1. not use antibiotics for apparent viral infection (sinusitis, pharyngitis, bronchitis) -- still used too much, though rates have fallen
2. not give cough/cold remedies to kids under 4
3. not do CT for minor head injuries. clinical observation often sufficient and less radiation.
4. not do neuroimaging in kid with simple febrile seizure
5. not routinely do abdominal CT in kids with abdominal pain (again, too much radiation and often risks>benefits)
6. no advantage to high dose steroids for prevention/treatment of bronchopulmonary dysplasia in premies
7. not order IgE screening panels for food allergies without reasonable medical history (too many false positives: eg, 8% of population test positive for peanut allergy, but 1% are really allergic)
8. not use acid blockers or motility agents (eg metoclopromide) routinely in reflux (GER). GER is normal in infants and should not be treated unless affecting growth/resp sx. not usually necessary to do GI tract imaging to diagnose.
9. not do surveillance urine cultures to detect asymptomatic bacteruria
10. not routinely use infant home apnea monitors to prevent SIDS (may be reasonable if infant at risk for apnea or cardiovasc events).

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